|Patterns and distribution of tobacco consumption in India: Cross sectional multilevel evidence from the 1998-9
National Family Health Survey|
||Subramanian, S.V., S. Nandy, M.Kelly, D. Gordon, G.D. Smith
||British Medical Journal, Vol 328, Page: 801-806
||Objective To investigate the demographic,
socioeconomic, and geographical distribution of
tobacco consumption in India.
Design Multilevel cross sectional analysis of the
1998-9 Indian national family health survey of
301 984 individuals in 92 447 households in 3215
villages in 440 districts in 26 states.
Setting Indian states.
Participants 301 984 adults ( = 18 years).
Main outcome measures Dichotomous variable for
smoking and chewing tobacco for each respondent
(1 if yes, 0 if no) as well as a combined measure of
whether an individual smokes, chews tobacco, or both.
Results Smoking and chewing tobacco are
systematically associated with socioeconomic markers
at the individual and household level. Individuals with
no education are 2.69 times more likely to smoke and
chew tobacco than those with postgraduate education.
Households belonging to the lowest fifth of a standard
of living index were 2.54 times more likely to consume
tobacco than those in the highest fifth. Scheduled tribes
(odds ratio 1.23, 95% confidence interval 1.18 to 1.29)
and scheduled castes (1.19, 1.16 to 1.23) were more
likely to consume tobacco than other caste groups. The
socioeconomic differences are more marked for
smoking than for chewing tobacco. Socioeconomic
markers and demographic characteristics of individuals
and households do not account fully for the differences
at the level of state, district, and village in smoking and
chewing tobacco, with state accounting for the bulk of
the variation in tobacco consumption.
Conclusion The distribution of tobacco consumption
is likely to maintain, and perhaps increase, the current
considerable socioeconomic differentials in health in
India. Interventions aimed at influencing change in
tobacco consumption should consider the
socioeconomic and geographical determinants of
people’s susceptibility to consume tobacco.